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General NPI Number Information
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NPI Number | 1154681963
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Entity Type | Individual
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Provider Name | MARY A. JOHNSON PH.D., LPC
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Gender | Female
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Dates
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Enumeration Date | 05/25/2012
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 202 SE DORION AVE SUITE 103
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City | PENDLETON
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State | OR
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Zip | 97801-2576
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Country | US
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Telephone | 541-276-2471
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Fax |
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Provider Business Mailing Address
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Address Line | 202 SE DORION AVE SUITE 103
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City | PENDLETON
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State | OR
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Zip | 97801-2576
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Country | US
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Telephone | 541-276-2471
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C2898
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 92271
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License Number State | NM
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